Len

Len is an elderly-appearing man – disheveled in appearance, but very personable and polite. I was stunned when I looked at his chart, only to discover he is actually 4 years younger than me!

He has been a patient at the clinic for the past 2 ½ years; he first came to have some stitches removed following a visit to the emergency room. Several months later, he started coming on a regular basis for his medications to maintain his epilepsy, high blood pressure, and heart disease.

Early this year, he began complaining of leg and hip pain – his one foot was always cold; we suspected some type of arterial insufficiency (lack of blood flow to his leg) and ordered tests to determine if this was the cause.

What we found was possible cancer – he has multiple lesions on his hip, back, and leg. Today he is having a biopsy to determine the source and type of cancer.

To state the obvious – he has no insurance. He has seasonal work at one of the township dumps collecting scrap metal. He lives with his mother.

I don’t know if having insurance would have expedited the process of diagnosing his cancer. What I do know is that IF he had insurance, he would be able to have the testing that he needs to complete the diagnostic work-up. But, because he is uninsured and our hospital does not have the equipment, he has been told he cannot have the necessary testing.  It will delay the staging of his cancer, and thus will impact the prognosis.

How can we proclaim ourselves a “Christian Nation” and yet not take care of the poor among us? How is this right?

As I sit here with Len and Paul’s charts on my desk feeling so helpless, I wonder at all the people out in the world screaming and yelling about “Obamacare” and how it is the end of the world as we know it. Yet, these two men are facing the real end of the world – and still don’t have access to healthcare (Medicaid expansion doesn’t take effect in Michigan until April 1). These two men don’t qualify for any of the tax subsidies – their income is below 100% of the Federal Poverty Guidelines, so there is no way they can afford insurance.

My phone calls to the Department of Human Services worker will help. She has a heart of gold, and will do all in her ability to make sure they qualify for emergency Medicaid. Hopefully, it won’t be too late.

Paul

We saw a patient at the clinic last week. He had dysphagia – a fancy word for difficulty swallowing. He was unable to keep any food down, was losing weight, and had a history of diabetes and high cholesterol. It was his first time at the clinic. He reported not taking his medications for about two weeks due to not being able to keep them down. He was living on fluids, at least the ones that he could keep down.

The PA who saw him was concerned that he might have cancer. I marvel at their instincts and knowledge – with the little we have to go on here.

So, he ordered an x-ray and an EGD or an esophagogastroduodenoscopy, which is a common procedure used to screen the upper digestive tract for growths or foreign bodies. It is performed by inserting a bendable tube that acts like a camera into the throat to look at the esophagus, stomach, and small intestine. Upper digestive tract problems that can be found through this procedure include gastro-esophageal reflux disease, peptic ulcers, and abnormal growths.

This is not a test that is typical of services provided by a free clinic. Fortunately for us, one of the local doctors agreed to do this test for this gentleman. And, they found cancer.

He was admitted to the hospital because he was not able to keep any fluids down after the procedure. From there, he was transferred to a larger hospital for treatment. The plan is for him to have surgery after he goes through some radiation therapy. Currently, he is on a feeding tube to provide some nutrients.

Remember – he has no insurance. He should qualify for Medicaid – hopefully soon. He will be sent home on tube feedings, with home care coming in to assist him. At this point, it has been set up as “private pay.” He has a part-time job working 24 hours a week for $8/hour. And, when he doesn’t work, he doesn’t get paid.

He has no family in the area. He had difficulty getting transportation to the hospital for his EGD last week. In a rural area like this, transportation is a real challenge for people.

It overwhelms me to think about what he is facing – and I would have the resources to deal with these issues. He doesn’t, and, he is sick – really sick.

This is just another of a million reasons why people need health insurance. It would be one less thing for him to worry about…

Conflicted!

After a couple of months of helping people obtain insurance through the Marketplace … I feel conflicted. I am of the opinion that people are better off with insurance – 24/7. There is never a time or place where NOT having insurance is a good thing. But, the Marketplace definitely has some challenges.

Today I worked with a young woman for the second time. Because she has never had a loan or a credit card, we are unable to verify her identity. At least now we know what the issue is and how to address it, but it has taken about three hours over two afternoons to get to this point. And, to get her qualified and enrolled in insurance will take one more trip to my office. Luckily, her mom knows how important it is for her to have healthcare insurance, and is supporting her in this. On their own, I’m pretty sure they would have given up.

This morning, I helped a man qualify for healthcare coverage. He hasn’t been able to work for some time due to a back injury. His wife works and has insurance through her employer. She makes minimum wage, with some opportunity for overtime. As we worked our way through his application, with the tax subsidies and cost sharing he is entitled to, he can purchase healthcare insurance for as little as $10.92 a month, with a low deductible and out-of-pocket maximum. For him, the Marketplace worked. No pre-existing condition exclusion, subsidies that really help and a good product – real health insurance.

A couple of individuals I have worked with have very low income, and qualify for some tax subsidies, but because they smoke, the cost of their insurance is less affordable for them. They have to really look at their budget, and make the decision if they can afford the health insurance. Yeah, I know – if they quit smoking, they could afford it. If only it were that easy. Our smoking cessation classes prove that quitting smoking is not easy – it often takes more than one time through the program to be successful. Some people never are.

But, I wonder – we (by that I mean, the Affordable Care Act) penalize those who smoke, but not those who are obese or those who refuse to exercise, or those who make other lifestyle choices that also cause health issues. So, is it fair? I don’t know. Life isn’t fair – so, it’s complicated.

I have to tell you – I am so excited every time someone walks out my door newly enrolled in healthcare. It is truly a time for celebration. I wonder at all of those who are so opposed to the healthcare law… do they really know what it means for people to NOT have health insurance?

Maureen

She didn’t look like a free clinic patient. She was attractive, dressed in a classical style, fit  and  trim. But, here she was… at the free clinic. She had been a patient here for almost a year before I met her and heard her story.

For 40 years she was married to a financial planner; they had the world on a string – a lovely home, two children, trips, and cars… pretty much a dream life. Until it became a nightmare.

She never suspected. It turns out her husband had embezzled hundreds of thousands of dollars from his clients. She never suspected, and still blames herself at some level.

She was another of his victims – he not only stole her retirement fund, but when he went to jail for his crimes, she lost everything. The house, the cars, the lifestyle. And, she lost herself.

In a heartbeat, she went from being a “have” to being a “have-not.” She has learned the harsh truths of the world in the worst possible way. She moved to another state with one of her children – she worked, but was uninsured. And, she was unable to obtain care.

Then life dealt her another blow – her mother was diagnosed with Alzheimer’s. So she returned here, to her hometown, to be the caregiver. For those of you who have walked this path – you know how difficult it is – mentally, physically, and emotionally. It is a 24/7 job with no benefits – no time off – and it takes a toll.

She came here for medications to control her diabetes and blood pressure. The night I met her was her last time here; she is now 65 and qualifies for Medicare. So, now she will have real healthcare.

Her story reminds me of how vulnerable we all are; we never know what is around the corner. Life can seem easy and good, but most of us are just two paychecks away from needing the support of our community. That is a pretty humbling thought.

Happy Valentine's Day!

A Message from the First Lady

Hi,

As a mom, I know life gets busy. Most folks already have way too much on their plates -- they shouldn't have to worry about health care coverage, too.

We all deserve the security that comes from having health coverage that's there for us -- that we can count on when we need it most.

If you still don't have health insurance, you can go to HealthCare.gov, compare your options, and pick a plan that fits your needs and your budget.

And if you're already covered, make sure the people you love are covered, too.

Millions of moms, dads, and Americans across the country have already picked out affordable plans that work for them. They've done this because they know that life throws you plenty of curveballs. That's what getting covered is all about: being ready for whatever comes your way.

This isn't about politics -- it's about peace of mind for you and for your family.

So if you still need health insurance, go to HealthCare.gov and select a plan.

And if you're already covered, I need your help: Forward this message to a friend or loved one who needs to see it and make sure they've signed up for health insurance, too.

Our health -- and the health of our families -- depends on it.

Thanks,

First Lady Michelle Obama